Trauma, Memory and the Brain

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Trauma changes our brains on a fundamental level, the psychologically traumatised brain causes inscrutable eccentricities which can (and do) cause it to overreact – or misreact – to stimulus and the realities of life. These neurological “misreactions” become established in part due to the effect that trauma has on the release of certain stress-responsive hormones, such as norepinephrine, along with the effect upon various areas of the brain involved in memory – particularly the amygdale and the hippocampus.

The amygdale is the part of the brain responsible for communicating the emotional importance and evaluation, via the thalamus, of sensory information to the hippocampus. In accordance with the amygdales evaluation the hippocampus will activate to a greater or lesser degree, and functions to organise this information and integrate it with previous similar sensory events. Under a normal range of situations and conditions this system works well and effectively to consolidate memories according to their emotional priority and content. However, at the extreme upper end of this hormonal activation, as with traumatic situations, a breakdown occurs. Overwhelming emotional significance registered by the amygdale actually leads to a decrease in hippocampal activation, this results in some of the traumatic input not being organised properly, not being stored as a unified whole, and not being integrated with other memories. This results in isolated sensory images and bodily sensations that are not localised in time or even in situation, nor integrated with other events. In effect these fragments of memory float about in the mind, ready to reappear at any moment.

To make matters even more complex, trauma may temporarily such down Brocas area, the region of the brain which translates experience into language, the means that we more often use to relate our experience and feelings to others and even to ourselves.

Regular memories are formed and are subject to meaningful modification, they can be retrieved when needed and can be conveyed to others through language and expression. In contrast, traumatic memories include chaotic fragments, which are sealed off from modification or modulation. Such memory fragments are wordless, placeless, and eternal. Long after the trauma has receded into the past the brains record of them may remain a fractured mass of isolated and confused emotion, images and sensations which can ring through the person like an alarm at any moment.

These sensations and feelings may not be labelled as part as belonging to memories from long ago, in fact they may not be labelled at all, as they may have been formed without language. They merely are, they come forward to take over the body giving no explanation, no narrative, no place or time, they are free-form and ineffable.

The traumatised brain has, effectively, a broken warning device in its limbic system. A bit like an old fuse box where the fuses tend to melt for no reason, reacting to an emergency when there is none.

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self injury, dissociation and amnesia

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Self-injury in all its forms, including accident-proneness or a tendency to be victimised again in abusive relationships, may actually constitute screen memories of abuse or symbolic memories that a person is using to keep explicit abuse memories out of consciousness. Repeatedly hurting oneself is a way of not having to remember the original hurt. Self-wounding may also be an unconscious repetition of past abuse in an attempt to make sense of a dim but haunting memory. The person is trying to knit the implicit remnant of the trauma memory into fabric of a continuous mental narrative.

The amnesia that many self-injurers have for their destructive behaviour may be related to the return of memories from which they have disconnected. Since the emotional pain of returning memories is overwhelming, the person enters a trancelike state in an effort to keep them blocked. Self-injurers with dissociative disorders often say that they “find themselves” with injuries on their bodies in the same way that they in strange places without knowing how they got there. Self-injuring can be a form of reality testing for abuse that the person, on some level, knows happened but has split off from consciousness. Injuring oneself can bring “forgotten” memories of abuse into the awareness in several ways. The wounds themselves can reinforce the reality of past abuse, long disavowed by dissociation and the persistent denials of family members who maintain that the abuse never happened or was an expression of love. The pain of self-injury can test reality by restoring the feeling of being alive. Self-injury can also re-enact past abusive events symbolically, recalling them behaviourally, and reinforce the persons conviction that he/she was abused as a child. The fear of remembering what one was forbidden to remember may make amnesia a survival tactic once again.

What is depersonalizaton?

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Depersonalization is a mental state in which a person feels detached or disconnected from his or her personal identity or self. This may include the sense that one is “outside” oneself, or is observing one’s own actions, thoughts or body.

A person experiencing depersonalization may feel so detached that he/she feels more like a robot than a human being. However, the person always is aware that this is just a feeling; there is no delusion that one is a lifeless robot or that one has no personal identity. The sense of detachment that characterises the state may result in mood shifts, difficulty thinking, and loss of some sensations – a state that can be described as numbness or sensory anesthesia. Twice as many women as men are treated for depersonalization, which can last from a few seconds to years. Episodes may increase after traumatic events such as exposure to combat, accidents or other forms of violence or stress . Treatment is difficult and the state is often chronic, although it may occur during discrete periods or increase and decrease in intensity over time. Individuals with depersonalization often feel that events and the environment are unreal or strange, a state called derealization

Findings in 2002 indicate that emotional abuse in particular is a strong predictor of depersonalization disorder in adult life, as well as of depersonalization as a symptom in other mental disorders. Analysis of one study of 49 patients diagnosed with depersonalization disorder indicated much higher scores than the control subjects for the total amount of emotional abuse endured and for the maximum severity of this type of abuse. The researchers concluded that emotional abuse has been relatively neglected by psychiatrists compared to other forms of childhood trauma.

It is thought that abuse in childhood or trauma in adult life may account for the distinctive cognitive (knowledge-related) profile of patients with depersonalization disorder. These patients have significant difficulties focusing their attention, with spatial reasoning, and with short-term visual and verbal memory. However, they have intact reality testing. (Reality testing refers to a person’s ability to distinguish between their internal experiences and the objective reality of persons and objects in the outside world.) Otherwise stated, a patient with depersonalization disorder may experience his/her body as unreal, but knows that “feelings aren’t facts”. The DSM-IV-TR specifies intact reality testing as a diagnostic criterion for depersonalization disorder.

What is dissociation?

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Dissociation is a mechanism that allows the mind to separate or compartmentalise certain memories or thoughts from normal consciousness. These split-off mental contents are not erased. They may resurface spontaneously or be triggered by objects or events in the person’s environment.

Dissociation is a process that occurs along a spectrum of severity. If someone experiences dissociation, it does not necessarily mean that that person has a dissociative disorder or other mental illness. A mild degree of dissociation occurs with some physical stressors; people who have gone without sleep for a long period of time, have had “laughing gas” for dental surgery, or have been in a minor accident often have brief dissociative experiences. Another commonplace example of dissociation is a person becoming involved in a book or movie so completely that the surroundings or the passage of time are not noticed. Another example might be driving on the highway and taking several exits without noticing or remembering. Dissociation is related to hypnosis in that hypnotic trance also involves a temporarily altered state of consciousness. Most patients with dissociative disorders are highly hypnotisable.

People in other cultures sometimes have dissociative experiences in the course of religious (in certain trance states) or other group activities.

Moderate or severe forms of dissociation are caused by such traumatic experiences as childhood abuse , combat, criminal attacks, brainwashing in hostage situations, or involvement in a natural or transportation disaster. Patients with acute stress disorder , post-traumatic stress disorder (PTSD), conversion disorder, or somatisation disorder may develop dissociative symptoms. Recent studies of trauma indicate that the human brain stores traumatic memories in a different way than that of normal memories. Traumatic memories are not processed or integrated into a person’s ongoing life in the same fashion as normal memories. Instead they are dissociated, or “split off,” and may erupt into consciousness from time to time without warning. Over a period of time, these two sets of memories, the normal and the traumatic, may coexist as parallel sets without being combined or blended. In extreme cases, different sets of dissociated memories may cause people to develop separate personalities for these memories – a disorder known as dissociative identity disorder (formerly called multiple personality disorder).

Useful books and articles on DID, dissociation and trauma

We’ve had a few requests for sources on dissociation, PTSD, DID, etc. Now bare with us, we are not very good at referancing lol, so hopefully got the format right 😛

Benjamin, L. R., & Benjamin, R. (1993). Interventions with children in dissociative families: A family treatment model. Dissociation

Braun, B. G. (1985). The transgenerational incidence of dissociation and multiple personality disorder: A preliminary report. In R. P. Kluft (Ed.), Childhood antecedents of multiple personality (pp. 127–150). Washington, DC: American Psychiatric Press.

Coons, P. M. (1985). Children of parents with multiple personality disorder. In R. P. Kluft (Ed.), Childhood antecedents of multiple personality. Washington, DC: American Psychiatric Press

Dell, D. F., & Eisenhower, J. W. (1990). Adolescent multiple personality disorder: a preliminary study of eleven cases. Journal of the American Academy of Child and Adolescent Psychiatry

Kluft, R. P. (1986). Treating children who have multiple personality disorder. In B.G. Braun (Ed.), Treatment of multiple personality disorder. Washington, DC: American Psychiatric Press

McMahon, P. P., & Fagan, J. (1993). Play therapy with children with multiple personality disorder. In R. P. Kluft & C. G. Fine (Eds.), Clinical perspectives on multiple personality disorder (pp. 253–76). Washington, DC: American Psychiatric Press

Waters, F. W. (1990). Profile of nine cases of childhood multiple personality disorder (Summary). Paper presented at Seventh International Conference on Multiple Personality/Dissociative States, Chicago, IL

Journal of Trauma & Dissociation

Lauren E. Duncan, Linda M. Williams. Gender role socialization and male-on-male vs. female-on-male child sexual abuse. Sex Roles: A Journal of Research, November 01 1998. Page(s): 14

J. LeDoux. The Emotional Brain. New York: Simon & Schuster, 1996.

D. Laub & N. Auerhahn. Knowing and not knowing massive psychic trauma: forms of traumatic memory. International Journal of Psychoanalysis(1993) 74, 287-302.

L.Nadel & W. Jacobs. Traumatic memory is special. Current directions in psychological science (1998) 7(5), 154-157

M. Hunter. Abused boys: The neglected victims of sexual abuse. Americam journalof psychiatry (1993) 150, 1043-1047

Patterns if sexual abuse among men

Study of victims of male rape

Sidran Institute

Also the books that we review here are pretty good sources of information

Forms of dissociative disorder

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Dissociation is a mental process, which produces a lack of connection in a person’s thoughts, memories, feelings, actions, or sense of identity. During the period of time when a person is dissociating, certain information is not associated with other information as it normally would be. For example, during a traumatic experience, a person may dissociate the memory of the place and circumstances of the trauma from his/her ongoing memory, resulting in a temporary mental escape from the fear and pain of the trauma and, in some cases, a memory gap surrounding the experience. Because this process can produce changes in memory, people who frequently dissociate often find their senses of personal history and identity are affected.

Most clinicians believe that dissociation exists on a continuum of severity. This continuum reflects a wide range of experiences and/or symptoms. At one end are mild dissociative experiences common to most people, such as daydreaming, highway hypnosis, or “getting lost” in a book or movie, all of which involve “losing touch” with conscious awareness of one’s immediate surroundings. At the other extreme is complex, chronic dissociation, such as in cases of Dissociative Disorders, which may result in serious impairment or inability to function. Some people with Dissociative Disorders can hold highly responsible jobs, contributing to society in a variety of professions, the arts, and public service — appearing to function normally to coworkers, neighbors, and others with whom they interact daily.

Depersonalization

Persistent or recurrent experiences of feeling detached from, and as if one is an outside observer of, one’s mental processes or body (e.g., feeling like one is in a dream).

During the depersonalization experience, reality testing remains intact.

The depersonalization causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The depersonalization experience does not occur exclusively during the course of another mental disorder, such as Schizophrenia, Panic Disorder, Acute Stress Disorder, or another Dissociative Disorder, and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., temporal lobe epilepsy).

Dissociative Fugue

Dissociative Fugue is one or more episodes of amnesia in which the inability to recall some or all of one’s past and either the loss of one’s identity or the formation of a new identity occur with sudden, unexpected, purposeful travel away from home.

Specific symptoms include:

  • The predominant disturbance is sudden, unexpected travel away from home or one’s customary place of work, with inability to recall one’s past.
  • Confusion about personal identity or assumption of a new identity (partial or complete).
  • The disturbance does not occur exclusively during the course of Dissociative Identity Disorder and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., temporal lobe epilepsy).
  • The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The length of a fugue may range from hours to weeks or months, occasionally longer. During the fugue, the person may appear normal and attract no attention. The person may assume a new name, identity, and domicile and may engage in complex social interactions. However, at some point, confusion about his identity or the return of the original identity may make the person aware of amnesia or cause distress.

The prevalence of dissociative fugue has been estimated at 0.2%, but it is much more common in connection with wars, accidents, and natural disasters. Persons with dissociative identity disorder frequently exhibit fugue behaviors.

The person often has no symptoms or is only mildly confused during the fugue. However, when the fugue ends, depression, discomfort, grief, shame, intense conflict, and suicidal or aggressive impulses may appear–ie, the person must deal with what he fled from. Failure to remember events of the fugue may cause confusion, distress, or even terror.

A fugue in progress is rarely recognized. It is suspected when a person seems confused over his identity, puzzled about his past, or confrontational when his new identity or the absence of an identity is challenged. Sometimes the fugue cannot be diagnosed until the person abruptly returns to his prefugue identity and is distressed to find himself in unfamiliar circumstances. The diagnosis is usually made retroactively based on the history with documentation of the circumstances before travel, the travel itself, and the establishment of an alternate life. Although dissociative fugue can recur, patients with frequent apparent fugues usually have dissociative identity disorder

Most fugues are brief and self-limited. Unless behavior has occurred before or during the fugue that has its own complications, impairment is usually mild and short-lived. If the fugue was prolonged and complications due to behavior before or during the fugue are significant, the person may have considerable difficulties–eg, a soldier may be charged as a deserter, and a person who marries may have inadvertently become a bigamist.

In the rare case in which the person is still in the fugue, recovering information (possibly with help from law enforcement and social services personnel) about his true identity, figuring out why it was abandoned, and facilitating its restoration are important.

Treatment involves methods such as hypnosis or drug-facilitated interviews. However, efforts to restore memory of the fugue period are often unsuccessful. A psychiatrist may help the person explore inner and interpersonal patterns of handling the types of situations, conflicts, and moods that precipitated the fugue to prevent subsequent fugue behavior.

Dissociative Amnesia

The predominant disturbance is one or more episodes of inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by ordinary forgetfulness.

The disturbance does not occur exclusively during the course of Dissociative Identity Disorder, Dissociative Fugue, Posttraumatic Stress Disorder, Acute Stress Disorder, or Somatization Disorder and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a neurological or other general medical condition (e.g., Amnestic Disorder Due to Head Trauma).

The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Dissociative Identity Disorder

The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self).

At least two of these identities or personality states recurrently take control of the person’s behavior.

Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.

The disturbance is not due to the direct physiological effects of a substance (e.g., blackouts or chaotic behavior during Alcohol Intoxication) or a general medical condition (e.g., complex partial seizures). Note: In children, the symptoms are not attributable to imaginary playmates or other fantasy play.

DDNOS
Dissociaitive disorder nos otherwise specified is when a person has some of the symptoms of a dissociaitve disoreder but do not fulfill any of the specific diagnosic criteria.

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